Differential Distraction for Relapsed Clubfoot Deformity in Children

Abstract

Purpose. To evaluate the long-term outcome of clubfoot correction following differential distraction using the Joshi external stabilisation system (JESS). Methods. 13 male and 9 female patients aged 1.5 to 5 years with 28 idiopathic clubfeet underwent differential distraction using JESS for relapsed deformity after posteromedial soft-tissue release. They were available for review after a mean of 12 years. Deformities of the feet were rigid and graded as Dimeglio type III or more. Pain, function, and satisfaction were evaluated using a questionnaire. Alignments of the forefoot and hindfoot, subtalar motion, ankle range of movement, muscle power, foot size, calf circumference, and limb length discrepancy were also evaluated. Each foot was rated using the Ponseti scale. Results. In 16 patients with unilateral clubfoot, the abnormal side differed significantly from the normal side in terms of foot size, calf circumference, ankle motion, and Ponseti score. Most affected feet were smaller. The mean Ponseti score for the 28 clubfeet was 80. 20 of the feet had good-to-excellent and 5 had fair scores, whereas 3 had poor scores (because of recurrence of deformity). Most patients were able to perform activities of daily living without any problem. The function of the ankle and subtalar joints was limited. Only 3 feet achieved ankle dorsiflexion of >10°, 15 were beyond neutral to 10°, 7 were neutral, and 3 were less than neutral. Most patients developed pin site infection, but none necessitated premature removal of the assembly or any surgical intervention. Conclusion. Differential distraction using JESS enabled long-term maintenance of correction and good function, despite hindfoot stiffness.